Provider Demographics
NPI:1205582962
Name:DELEON, ASHLY MARIANA (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ASHLY
Middle Name:MARIANA
Last Name:DELEON
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 GRISWOLD DR APT B23
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4170
Mailing Address - Country:US
Mailing Address - Phone:574-301-9570
Mailing Address - Fax:
Practice Address - Street 1:1300 E WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4556
Practice Address - Country:US
Practice Address - Phone:574-301-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2024-07-09
Deactivation Date:2023-06-23
Deactivation Code:
Reactivation Date:2024-07-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer